|
SLEEVE TI MOD HEAD 12/14 TPR +
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+0
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+0
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+4
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+4
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR-4
|
Facility
|
IP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR-4
|
Facility
|
OP
|
$1,752.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.82 |
| Max. Negotiated Rate |
$1,682.40 |
| Rate for Payer: Aetna Commercial |
$1,349.42
|
| Rate for Payer: Anthem Medicaid |
$602.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.95
|
| Rate for Payer: Cash Price |
$876.25
|
| Rate for Payer: Cigna Commercial |
$1,454.58
|
| Rate for Payer: First Health Commercial |
$1,664.88
|
| Rate for Payer: Humana Commercial |
$1,489.62
|
| Rate for Payer: Humana KY Medicaid |
$602.68
|
| Rate for Payer: Kentucky WC Medicaid |
$608.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,437.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.28
|
| Rate for Payer: PHCS Commercial |
$1,682.40
|
| Rate for Payer: United Healthcare All Payer |
$1,542.20
|
|
|
SLEEVE UNIV C-TAPER +5
|
Facility
|
OP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem Medicaid |
$731.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Humana KY Medicaid |
$731.96
|
| Rate for Payer: Kentucky WC Medicaid |
$739.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEVE UNIV C-TAPER +5
|
Facility
|
IP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEVE UNIVERSAL FEMORAL 46MM
|
Facility
|
OP
|
$18,031.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.06 |
| Max. Negotiated Rate |
$17,309.95 |
| Rate for Payer: Aetna Commercial |
$13,884.02
|
| Rate for Payer: Anthem Medicaid |
$6,200.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,064.34
|
| Rate for Payer: Cash Price |
$9,015.60
|
| Rate for Payer: Cigna Commercial |
$14,965.90
|
| Rate for Payer: First Health Commercial |
$17,129.64
|
| Rate for Payer: Humana Commercial |
$15,326.52
|
| Rate for Payer: Humana KY Medicaid |
$6,200.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,264.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,785.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,307.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,409.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,325.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,867.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,523.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,606.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,589.67
|
| Rate for Payer: PHCS Commercial |
$17,309.95
|
| Rate for Payer: United Healthcare All Payer |
$15,867.46
|
|
|
SLEEVE UNIVERSAL FEMORAL 46MM
|
Facility
|
IP
|
$18,031.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.06 |
| Max. Negotiated Rate |
$17,309.95 |
| Rate for Payer: Aetna Commercial |
$13,884.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,064.34
|
| Rate for Payer: Cash Price |
$9,015.60
|
| Rate for Payer: Cigna Commercial |
$14,965.90
|
| Rate for Payer: First Health Commercial |
$17,129.64
|
| Rate for Payer: Humana Commercial |
$15,326.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,785.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,307.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,409.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,867.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,523.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,606.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,589.67
|
| Rate for Payer: PHCS Commercial |
$17,309.95
|
| Rate for Payer: United Healthcare All Payer |
$15,867.46
|
|
|
SLEEVE UNIV FEM CEM 20MM
|
Facility
|
IP
|
$17,344.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.76 |
| Max. Negotiated Rate |
$16,650.55 |
| Rate for Payer: Aetna Commercial |
$13,355.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,528.57
|
| Rate for Payer: Cash Price |
$8,672.16
|
| Rate for Payer: Cigna Commercial |
$14,395.79
|
| Rate for Payer: First Health Commercial |
$16,477.10
|
| Rate for Payer: Humana Commercial |
$14,742.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,222.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,800.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,203.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,263.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,008.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,468.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,254.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,376.74
|
| Rate for Payer: PHCS Commercial |
$16,650.55
|
| Rate for Payer: United Healthcare All Payer |
$15,263.00
|
|
|
SLEEVE UNIV FEM CEM 20MM
|
Facility
|
OP
|
$17,344.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,254.76 |
| Max. Negotiated Rate |
$16,650.55 |
| Rate for Payer: Aetna Commercial |
$13,355.13
|
| Rate for Payer: Anthem Medicaid |
$5,964.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,528.57
|
| Rate for Payer: Cash Price |
$8,672.16
|
| Rate for Payer: Cigna Commercial |
$14,395.79
|
| Rate for Payer: First Health Commercial |
$16,477.10
|
| Rate for Payer: Humana Commercial |
$14,742.67
|
| Rate for Payer: Humana KY Medicaid |
$5,964.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,025.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,222.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,800.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,203.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,084.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,263.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,008.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,468.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,254.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,376.74
|
| Rate for Payer: PHCS Commercial |
$16,650.55
|
| Rate for Payer: United Healthcare All Payer |
$15,263.00
|
|
|
SLEEVE UNIV FEM DIS POR 31MM
|
Facility
|
OP
|
$21,002.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.31 |
| Max. Negotiated Rate |
$20,162.26 |
| Rate for Payer: Aetna Commercial |
$16,171.81
|
| Rate for Payer: Anthem Medicaid |
$7,222.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,381.83
|
| Rate for Payer: Cash Price |
$10,501.17
|
| Rate for Payer: Cigna Commercial |
$17,431.95
|
| Rate for Payer: First Health Commercial |
$19,952.23
|
| Rate for Payer: Humana Commercial |
$17,852.00
|
| Rate for Payer: Humana KY Medicaid |
$7,222.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,296.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,221.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,499.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,300.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,367.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,482.07
|
| Rate for Payer: Ohio Health Group HMO |
$15,751.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,200.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,730.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,510.73
|
| Rate for Payer: PHCS Commercial |
$20,162.26
|
| Rate for Payer: United Healthcare All Payer |
$18,482.07
|
|
|
SLEEVE UNIV FEM DIS POR 31MM
|
Facility
|
IP
|
$21,002.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.31 |
| Max. Negotiated Rate |
$20,162.26 |
| Rate for Payer: Aetna Commercial |
$16,171.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,381.83
|
| Rate for Payer: Cash Price |
$10,501.17
|
| Rate for Payer: Cigna Commercial |
$17,431.95
|
| Rate for Payer: First Health Commercial |
$19,952.23
|
| Rate for Payer: Humana Commercial |
$17,852.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,221.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,499.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,300.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,482.07
|
| Rate for Payer: Ohio Health Group HMO |
$15,751.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,200.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,730.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,510.73
|
| Rate for Payer: PHCS Commercial |
$20,162.26
|
| Rate for Payer: United Healthcare All Payer |
$18,482.07
|
|
|
SLEEVE UNIV FEM FP 31MM
|
Facility
|
OP
|
$28,202.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,666.38 |
| Max. Negotiated Rate |
$27,074.77 |
| Rate for Payer: Aetna Commercial |
$21,716.23
|
| Rate for Payer: Anthem Medicaid |
$9,698.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,998.25
|
| Rate for Payer: Cash Price |
$14,101.44
|
| Rate for Payer: Cigna Commercial |
$23,408.40
|
| Rate for Payer: First Health Commercial |
$26,792.75
|
| Rate for Payer: Humana Commercial |
$23,972.46
|
| Rate for Payer: Humana KY Medicaid |
$9,698.97
|
| Rate for Payer: Kentucky WC Medicaid |
$9,797.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,126.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,813.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,460.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,893.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,818.54
|
| Rate for Payer: Ohio Health Group HMO |
$21,152.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,640.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,666.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,742.90
|
| Rate for Payer: PHCS Commercial |
$27,074.77
|
| Rate for Payer: United Healthcare All Payer |
$24,818.54
|
|
|
SLEEVE UNIV FEM FP 31MM
|
Facility
|
IP
|
$28,202.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,666.38 |
| Max. Negotiated Rate |
$27,074.77 |
| Rate for Payer: Aetna Commercial |
$21,716.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,998.25
|
| Rate for Payer: Cash Price |
$14,101.44
|
| Rate for Payer: Cigna Commercial |
$23,408.40
|
| Rate for Payer: First Health Commercial |
$26,792.75
|
| Rate for Payer: Humana Commercial |
$23,972.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,126.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,813.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,460.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,818.54
|
| Rate for Payer: Ohio Health Group HMO |
$21,152.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,640.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,666.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,742.90
|
| Rate for Payer: PHCS Commercial |
$27,074.77
|
| Rate for Payer: United Healthcare All Payer |
$24,818.54
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +0
|
Facility
|
OP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem Medicaid |
$731.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Humana KY Medicaid |
$731.96
|
| Rate for Payer: Kentucky WC Medicaid |
$739.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +0
|
Facility
|
IP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +4
|
Facility
|
OP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem Medicaid |
$731.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Humana KY Medicaid |
$731.96
|
| Rate for Payer: Kentucky WC Medicaid |
$739.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +4
|
Facility
|
IP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEV UNIV V40 TPR ADPTER -2.5
|
Facility
|
OP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem Medicaid |
$731.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Humana KY Medicaid |
$731.96
|
| Rate for Payer: Kentucky WC Medicaid |
$739.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLEEV UNIV V40 TPR ADPTER -2.5
|
Facility
|
IP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.80
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
SLENDER SHEATH 5FR
|
Facility
|
OP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem Medicaid |
$373.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Humana KY Medicaid |
$373.65
|
| Rate for Payer: Kentucky WC Medicaid |
$377.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
SLENDER SHEATH 5FR
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
